Front-line cancer clinicians reluctant to prescribe antidepressants
MedWire News: Oncologists and surgeons are reluctant to prescribe antidepressants (ADs) to cancer patients, despite the drugs being recommended in this group, say UK researchers.
Specialists' main concerns are a lack of knowledge of current AD prescription practice and safety concerns about being unable to monitor patients, the study findings show.
General practitioners (GPs) were suggested to be the preferred prescribers, a view that was supported by clinical nurse specialists.
"Cancer is a significant psychological stressor and this, combined with insomnia and pain are significant risk factors for depression," say Patricia Holch, from the University of Leeds, and colleagues.
"The reluctance to prescribe may stem from the knowledge that oncology patients have an increased risk of suicide, compounded by the negative press coverage," they add in the BMJ Supportive and Palliative Care.
"This study also highlighted a tendency to see AD therapy as a backward step, which constituted 'giving in.' "
The team interviewed and analyzed the responses of 18 professionals involved in the care of cancer patients: eight oncologists, three surgeons, two clinical nurse specialists, and five ward nurses working in lung, breast, urologic, and colorectal cancer teams.
All participants were asked about their views on the use of ADs for cancer patients experiencing emotional distress, and their thoughts on prescribing practice.
Responses were divided into three themes, attitudes (positive and negative), knowledge (lack of knowledge surrounding prescription), and behavior (perceived own role and central role for GP).
Overall, the most support for AD use in cancer patients came from nurses, with five out of seven giving positive views.
"Their relatively positive views may reflect more contact with patients' distress and the absence of responsibility for prescribing," suggest the researchers.
Two out of three surgeons believed that ADs were overprescribed, and have a detrimental impact on patients' abilities to cope, while the majority (seven of 11) of oncologists did not state a clear view about the use of ADs. Two oncologists did express positive attitudes towards ADs, but only in an inpatient setting, when patients could be monitored.
Most surgeons and oncologists would not consider prescribing ADs in routine practice, report the researchers, with no surgeon interviewed saying they would, and only two out of eight oncologists saying they would consider it. Indeed one oncologist believed it would be "totally inappropriate" to prescribe ADs. Reasons for these responses were cited as not feeling equipped to monitor patients, and being unfamiliar with prescribing practices.
In all, nine out of 11 physicians agreed that GPs were the most appropriate professional to prescribe ADs, which nurse-respondents agreed with.
However, "it is not clear whether hospital doctors communicate this to the GP or whether patients are relied upon to broach this with their GP independently," write the authors.
They conclude: "The management of depression in cancer patients could be greatly improved by clear management strategies for treatment including the use of ADs together with better identification of cases of depression using a screening system."
By Sarah Guy